Road to the Marathon: Jeremy’s Marathon Training, Part III

Join us as we follow Jeremy LaMothe, HSS Fellow and first time marathon runner, through his training for the ING New York City Marathon. This is the third installment of a series documenting his journey, read the first here and second here.

Since my last post, I’ve tried to “smear my homunculus” and explore the good and bad pains of training. I’ve participated in races of 3, 10 and 18 miles and also a half marathon. This is my last hard week of training before a taper leading up to the marathon so I feel like I can comment on this with some more authority now. Calf + quads muscle pain = good pain. Diaphragm cramp = good pain. A pulled hamstring while doing sprints that leaves a very large bruise on my thigh = bad pain. Unrelenting right hip pain with weight bearing after an 18 mile race = very bad pain. I actually had the hip pain checked out to rule out a stress fracture. The pain is still there, but slowly improving and I can carry on with lots of Ibuprofen on board. Hitting the wall = very bad pain.

Previous to my marathon training, I had heard that “hitting the wall” is a term reserved for a sudden catastrophic slowing of pace accompanied by an intense sense of dysphoria; think of the winter that stopped Napoleon. It usually happens some time after mile 18. Doesn’t sound like something I want to be a part of, but unfortunately, according to my medical literature searches, up to 75% of marathon runners hit the wall in some form or another. The only difference seems to be how tall it is. Some runners only slow their pace a little bit near the end of a marathon, and some are reduced to walking or not finishing. More than a Pink Floyd album, “The Wall” is a raucous beast poised to abduct your ability to reach the finish line. Although I haven’t met him yet, I have heard him breathing dangerously close behind me at mile 22 in my last long training run.

The Wall steals time from runners for a couple of reasons. First, no energy supplies (glycogen) left in the legs equates to an empty tank and no more running. Second, low blood glucose leads to cerebral hypoglycemia, which can manifest as fatigue/anhedonia that strips all desire to continue. My first instinct was that more training could help manage The Wall. However, I learned it is so much more than this when I attended an excellent marathon information session put on by HSS, Strategies for the Marathon Runner – Keeping You on Your Feet and Through the Finish Line. Among other excellent talks, HSS Sports Dietician Jason Machowsky spoke about nutrition. The analogy is quite simple, more fuel in the tank equals smaller wall. Diet is as important as physical training in running a marathon, and one needs to train to eat properly when going long distances. This is often neglected – it is surprising how much one needs to eat before and during the race. My wife is a chef so thought of eating ~3,800 extra carbohydrate calories of her treats the day before the race makes me smile. I should be carb loading for a few days before the race; finally gluttony is justified! However, caution should be taken when deciding what carbs to eat. Fibrous carbs can lead to gastrointestinal misfortunes, especially when training hard. After a few of my long training runs, I can definitely appreciate this. My intestines ache for a few hours to the point of anorexia after the long runs. Just as pre-race nutrition is important, in-race nutrition is key. I’ve been practicing taking in an energy goo every 4 miles on longer runs to keep some wood on the fire. I’ve learned that eating/drinking while running is difficult and messy. Maybe I should slow down to eat; not sure yet how I am going to manage this. For now, I just finished a half marathon race and I’m going to manage that with a few more peanut-butter bacon cookies.

Jeremy LaMothe is an orthopedic surgeon from Calgary, Canada who moved to New York City in July 2012 to pursue two years of Academic Training at the Hospital for Special Surgery. In his first year, he completed a Trauma Fellowship, and he is currently a Fellow with the Foot and Ankle Service. Jeremy started running more when moving to New York as a way to see the city from the pavement, and is training for his first marathon in November 2013. Other than running and cycling around the city, Jeremy’s wife, who is a classically trained chef, has helped him acquire a special interest and taste for the culinary arts.

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